The minimally invasive open pyeloplasty.
BACKGROUND
The dismembered pyeloplasty is the operation of choice for ureteropelvic junction obstruction (UPJO). Recently, with the advent of improved minimally invasive techniques and equipment, laparoscopic dismembered pyeloplasty has gained popularity. We present our experience with a minimally invasive open pyeloplasty.


METHODS
A retrospective review of the last 5 years of consecutive open pyeloplasties was performed with regard to age, surgical operative time, length of hospital stay, need for postoperative narcotics and surgical success.


RESULTS
Seventy-four patients had a dismembered pyeloplasty using an open flank incision: 34 patients (<1 year), 13 (1-5 years), 7 (5-10 years) and 20 (>10 years). Mean surgical time for patients according to age was: <1 year, 109.4+/-36.4 min; 1-5 years, 105.5+/-37.4 min; 5-10 years, 131.1+/-76.4 min; >10 years, 134+/-37.8 min. Mean incision sizes for the respective groups were 2.01+/-0.50 cm, 1.93+/-0.73 cm, 2.71+/-1.55 cm and 3.5+/-1.58 cm. The last 20 patients under 1 year of age had incisions of 1-1.5 cm. The majority of incisions were via a posterior subcostal muscle splitting approach. All patients received postoperative ketorolac and acetaminophen. Supplemental narcotics were not required in any patient less than 10 years old. All patients were discharged in <23 h. Radiologic and/or symptomatic improvement was seen in 70/74 (95%) patients after surgery.


CONCLUSIONS
The minimally invasive approach to open pyeloplasty is a safe and effective treatment choice for UPJO. In small children our technique can be easily performed through a small incision without excessive postoperative pain allowing for early discharge. Our results with a refined open surgical technique challenge the current trend in the literature that laparoscopic pyeloplasty techniques are superior with regard to cosmesis, length of stay and postoperative narcotic use.
Chacko
Job K
JK
Department of Pediatric Urology, The Children's Hospital, Denver, CO, USA.
Koyle
Martin A
MA
Mingin
Gerald C
GC
Furness
Peter D
PD